September 2009

NASW-NYC’s Annual Addictions Institute on May 27, 2009 featured keynote speaker Timothy O’Farrell, Ph.D., Professor of Psychology at Harvard Medical School and the Director of the Families and Addictions Program at the VA Boston Healthcare System. Dr. O’Farrell, who also directs the VA’s project on marriage counseling for alcoholics, shared that he feels very close to the social work profession and has been significantly influenced by social workers, including Margaret Bailey, who did pioneering work with the wives of alcoholics, and by his first supervisor, who was a social worker.

Dr. O’Farrell shared the observation that among couples, when one partner drinks or abuses substances, the other partner suffers. The outcome is often distrust and distancing, resulting from conflict and lying about the substances. Partner violence, job loss and the suffering of children are also common. The point is that substance abuse problems and family problems often go together, that they are intertwined. He said that when both are addressed, there are better outcomes compared to treating the individual alone. Relationships fare better, there is decreased partner violence and decreased child distress, even though the child is not in treatment.

There are two primary objectives of behavioral couples therapy (BCT): to support abstinence and to improve relationship functioning. Dr. O’Farrell said that BCT is suitable for married couples and couples living together who are both willing to work on the problem. When both partners want to see an end to the substance abuse, BCT does very well. Although BCT is not appropriate for situations where there is a likelihood of severe violence, he said that 65% of all couples that his project has worked with have experienced some degree of violence. He said that violence is significantly reduced through BCT and only 5% of all couples are ruled out for this.

One of the primary points in BCT is to build support for abstinence. This starts with a focus on the issue of lying, which is in the forefront of treatment in the beginning. Dr. O’Farrell underscored the significance of lying in destroying relationships. He said that trust is built through rewarding abstinence, although it is not obvious that abstinence should be rewarded. He reviewed what his program calls the “daily trust discussion” in which the abusing partner states that he or she did not drink or use drugs yesterday, has no plan to do so today or tomorrow, and the other partner responds by saying “thanks.” He said that he starts people off using a script, but they move on to putting things into their own words. He emphasized that the focus is on the present and the future, not on the past.

BCT also focuses on relationship issues with an emphasis on increasing positive activities and communication skills. Other components of BCT include maintenance and relapse prevention and an action plan to keep the partner safe from potential violence. One of the points that Dr. O’Farrell shared is that it is better to avoid getting into an argument when a partner relapses. Arguing at such times increases the risk of violence.

Dr. O’Farrell is the author of Behavioral Couples Therapy for Alcoholism and Drug Abuse. This book can be ordered through a link on NASW’s website. It is also noted that NASW-NYC will hold a workshop, “Helping Families with Substance Abusing Members: A Systemic-Motivational Approach” by Peter Steinglass, M.D., on November 30, 2009.